MEDICARE: MR. OLUBUNMI ADETULE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ00654800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82-4734261	OTHER	NJ	TAX ID

General Provider Information

NPI Number	:	1245786979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OLUBUNMI ADETULE

Provider Business Mailing Address
First Line	:	11 DUNDAR RD STE 207
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3513
Country	:	US
Telephone Number	:	908-499-5375
Fax Number	:	908-368-8520

Provider Business Practice Location Address
First Line	:	11 DUNDAR RD STE 105
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3513
Country	:	US
Telephone Number	:	908-499-5375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	01/15/2020

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Directions to “ MR. OLUBUNMI ADETULE ” Practice Location

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